Intermenstrual Bleeding


Vaginal bleeding (other than post coital) at any time in the cycle other than during normal menstruation

IMB  could indicate endometrial hyperplasia, fibroids, cervical pathology


Red Flag Symptoms

  • Postmenopausal Bleeding (PMB)i.e. bleeding >12 months after last period
  • ·         PMB in patients <55y who DO NOT have high risk factors (such as obesity and high BMI, who are on Tamoxifen, or are suffering from unexplained recurrent PMB) Refer to PMB Clinic
  • ·         PMB not in above group REFER TO GYNAE ON 2WW FORM
  • Persistent Intermenstrual bleeding (IMB)if >45y or other risk factors for endometrial cancer (eg obesity, PCOS unopposed estrogen, tamoxifen) –Refer urgently to the Menstrual Disorders Clinic
  • Suspicious cervix on examinationRefer to 2ww


Information to include in referral letter
 to The Menstrual Disorders Clinic

  • Describe problem and length of symptoms
  • Current contraception
  • Any current other hormonal treatment
  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the consultation 
  • Relevant past medical / surgical history if not on proforma
  • Current regular medication if not on proforma
  • Speculum findings (eg normal / ectropion / cervicitis / cervical polyp)



Investigations prior to referral

  • Chlamydia screening
  • High Vaginal Swab
  • Pelvic USS
  • NB DON’T perform a cervical smear if outside the screening programme


Desirable Information 

  • Treatments tried so far if on hormonal contraception




Intermenstrual and postcoital bleeding patient.co.uk website

NICE Guideline Jan 2007 Heavy Menstrual Bleeding